ATOH1, TFAP2B, and CEACAM6 as Immunohistochemical Markers to Distinguish Merkel Cell Carcinoma and Small Cell Lung Cancer.

Merkel cell carcinoma (MCC) and small cell lung cancer (SCLC) can be histologically similar. Immunohistochemistry (IHC) for cytokeratin 20 (CK20) and thyroid transcription factor 1 (TTF-1) are commonly used to differentiate MCC from SCLC; however, these markers have limited sensitivity and specificity. To identify new diagnostic markers, we performed differential gene expression analysis on transcriptome data from MCC and SCLC tumors. Candidate markers included atonal BHLH transcription factor 1 (ATOH1) and transcription factor AP-2ß (TFAP2B) for MCC, as well as carcinoembryonic antigen cell adhesion molecule 6 (CEACAM6) for SCLC. Immunostaining for CK20, TTF-1, and new candidate markers was performed on 43 MCC and 59 SCLC samples. All three MCC markers were sensitive and specific, with CK20 and ATOH1 staining 43/43 (100%) MCC and 0/59 (0%) SCLC cases and TFAP2B staining 40/43 (93%) MCC and 0/59 (0%) SCLC cases. TTF-1 stained 47/59 (80%) SCLC and 1/43 (2%) MCC cases. CEACAM6 stained 49/59 (83%) SCLC and 0/43 (0%) MCC cases. Combining CEACAM6 and TTF-1 increased SCLC detection sensitivity to 93% and specificity to 98%. These data suggest that ATOH1, TFAP2B, and CEACAM6 should be explored as markers to differentiate MCC and SCLC.

Health Literacy Levels and Predictors Among Lebanese Adults Visiting Outpatient Clinics in Beirut.

BACKGROUND: To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon. OBJECTIVES: This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults. METHODS: A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels. KEY RESULTS: About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having inadequate CHL. CONCLUSION: This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon. [HLRP: Health Literacy Research and Practice. 2021;5(4):e295-e309.] Plain Language Summary: This study examined health literacy levels and correlates in 587 Lebanese adults using two recognized screening tools. The first tool measured functional health literacy (FHL), which represents the ability of a person to acquire information on health through reading or writing. The second tool assessed comprehensive health literacy (CHL), which encompasses the ability of a person to use their social skills to acquire health information from different media and make appropriate health decisions based on this information. Close to two-thirds of the participants had inadequate or problematic FHL. More specifically, low education, low socioeconomic status, and widowhood were predictive of inadequate FHL. Nearly one-half of the participants had inadequate or problematic CHL with an increased likelihood of inadequate levels in people with low FHL and low income.

Glioma-Associated Oncogene-1 Expression in Basal Cell Carcinoma and Its Histologic Mimics.

ABSTRACT: Basal cell carcinoma (BCC) is the most common skin cancer, and it has numerous histologic mimics with variable prognoses and treatments. Although some immunohistochemical stains can be used for the differential diagnosis of BCC, variability and overlap in results can complicate their interpretation. Immunohistochemical staining for glioma-associated oncogene-1 (Gli-1) was performed on 26 nodular BCCs, 22 infiltrative BCCs, 9 basaloid squamous cell carcinomas, 12 desmoplastic trichoepitheliomas, 19 Merkel cell carcinomas, 11 sebaceous carcinomas, 10 cylindromas, 14 spiradenomas, 12 adenoid cystic carcinomas (AdCC), and 1 solitary trichoepithelioma. Strength of staining was scored as 0, 1+, 2+, or 3+, and distribution of staining was categorized as diffuse, multifocal, or focal. Strong, diffuse Gli-1 expression was seen in all tumors with basal epidermal-type differentiation, including BCC, trichoepithelioma, and basaloid squamous cell carcinoma. All examples of Merkel cell carcinoma were negative for cytoplasmic expression. Seven out of 11 sebaceous carcinomas were negative for Gli-1, and the remaining 4 showed 1+ expression. Cylindroma, spiradenoma, and AdCC, each an adnexal skin tumor, showed the most variable staining, but with cylindroma and spiradenoma demonstrating comparable labeling patterns. Overall, although Gli-1 may not distinguish between basal epidermal-type tumors, it may have a role in separating that group from lesions with adnexal differentiation, particularly sebaceous carcinoma, but also cylindroma, spiradenoma, and AdCC. Any cytoplasmic staining seems to exclude the diagnosis of Merkel cell carcinoma.

A semi-continuous system for monitoring microbially influenced corrosion.

Microbially influenced corrosion (MIC), also known as biocorrosion, has significant impacts on the environment and economy. Typical systems to study biocorrosion are either dynamic (once-through flow) or static (serum bottle incubations). Dynamic systems can be materials and personnel intensive, while static systems quickly become nutrient limiting and exhibit long incubations. A semi-continuous biocorrosion cell was developed to address these issues. Low carbon shim steel was used as a test surface. Initial results revealed that 50 ppm glutaraldehyde (GLT), a common oil field biocide, in an abiotic cell was 3.6 times more corrosive (24.5 × 10-3 mm/y) than a biocorrosion cell inoculated with a sulfate-reducing bacteria (SRB) enrichment (6.73 × 10-3 mm/y). The SRB inoculated cell treated with GLT (50 ppm) reduced the corrosion rate from 6.73 × 10-3 mm/y to 3.68 × 10-3 mm/y. It was hypothesized that a biocide-surfactant combination would enhance biocide activity, thereby lowering corrosion in a semi-continuous biocorrosion cell. The biocide and surfactant were GLT (30 ppm) and Tween 80 (TW80; 100 ppm). MIC of SRB increased in the presence of a non-inhibitory concentration of GLT (23.4 × 10-3 mm/y), compared to the untreated +SRB condition (8.29 × 10-3 mm/y). The non-ionic surfactant alone reduced MIC (4.57 × 10-3 mm/y) and even more so in combination with GLT (3.69 × 10-3 mm/y). Over 50% of 16S rDNA sequences in the biofilm on the test surface were identified as belonging to the genera Desulfovibrio and Desulfomicrobium. The utility of a semi-continuous system for MIC studies and biocide testing was demonstrated. The concept of regular partial medium replacement is applicable to different corrosion cell and corrosion coupon geometries. Biocide-surfactant combinations may have the potential to reduce the concentration of biocides used in the field. In addition, a semi-defined medium for enumerating Acid-Producing Bacteria (APB) was developed, resulting in higher recoveries compared to a standard phenol red medium (e.g., 1.1 × 104 APB/cm2 vs < 4 × 10-1 APB/cm2).

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder-clinical and histopathologic features, differential diagnosis, and treatment.

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder usually presents as a slow-growing and asymptomatic solitary lesion in the form of a nodule or tumor in the head and neck region. By definition, it is histologically characterized by small- to medium-sized CD4+ lymphocytes involving the dermis in a dense and either nodular or diffuse pattern. Epidermotropism should be absent or minimal. Tumor cells are accompanied by numerous reactive B cells, plasma cells, histiocytes, and eosinophils. This lymphoproliferative disorder is characterized by the expression of follicular helper T-cell markers, particularly B-cell lymphoma 6 (BCL-6), programmed cell death protein 1 (PD-1), and C-X-C motif chemokine ligand 13 (CXCL-13), while CD10 is usually negative. Molecular studies show a clonal rearrangement of T-cell receptor genes in more than 60% of cases. Management of disease includes surgical excision, radiation therapy, and steroids (topical or intralesional). Patients with this diagnosis have an excellent prognosis, with a clinical course that is invariably indolent.

Cushing Disease in a patient with Multiple Endocrine Neoplasia type 2B.

CONTEXT: Multiple endocrine neoplasia type 2B (MEN2B) is a rare autosomal-dominant cancer syndrome characterized in part by metastatic medullary thyroid cancer (MTC) and pheochromocytoma. Cushing disease is a rare cause of endogenous hypercortisolism in children. CASE DESCRIPTION: We describe a 21-year-old African-American male who was diagnosed at age 10 with an ACTH-secreting pituitary microadenoma. At age 16 he developed medullary thyroid cancer and was found to have multiple endocrine neoplasia type 2B with the characteristic M918T mutation of the RET proto-oncogene. Following thyroidectomy, he was initiated on Vandetanib, a tyrosine kinase inhibitor, and has since had stable disease over the last 5 years. CONCLUSIONS: Our patient is the first individual with MEN2B to be described with Cushing disease. The RET oncogene may play a role in pituitary tumorigenesis; alternatively, the coexistence of these two entities may represent an extremely rare coincidence.

Seeking Standards for the Detection of Merkel Cell Polyomavirus and its Clinical Significance.

Merkel cell carcinoma is a rare skin cancer associated with Merkel cell polyomavirus in most cases. Prior studies associating Merkel cell carcinoma viral status with prognosis have inconsistent findings. Moshiri et al. used multimodal virus detection to determine that the 81% of patients with virus-positive Merkel cell carcinoma tumors had earlier stage disease and better outcomes relative to virus-negative cases.